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Published on: November 9, 2016
ED RAPID: A Novel Children's Hospital Direct Admission Process Utilizing the Emergency Department
Jeffrey P Louie1, Ronald A Furnival1, Mark G Roback1
1Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minn.
Insights
Direct hospital admission for children is common, but safety guidelines are lacking. The ED RAPID (Emergency Department Rapid Assessment of Patients Intended for Inpatient Disposition) process safely evaluated children, with most admitted directly to wards.
Area of Science:
- Pediatric Emergency Medicine
- Hospital Administration
- Patient Safety
Background:
- Direct hospital admission of children without emergency department (ED) evaluation presents safety challenges due to a lack of established guidelines for assessing patient stability.
- This study introduces a novel approach to enhance patient safety during direct admissions.
Purpose of the Study:
- To describe and evaluate the feasibility and effectiveness of the ED Rapid Assessment of Patients Intended for Inpatient Disposition (ED RAPID) process.
- To assess patient outcomes following direct hospital admission using the ED RAPID protocol.
Main Methods:
- An interdisciplinary team developed the ED RAPID process, involving a brief evaluation of vital signs and clinical stability by ED attending physicians and nurses.
- Children assessed as stable were directly admitted to inpatient wards; those needing immediate intervention received a full ED evaluation.
- Outcomes were retrospectively assessed for all children evaluated via ED RAPID from March 2013 to February 2015.
Main Results:
- 715 patients underwent ED RAPID evaluation, with 691 (96.4%) directly admitted to wards after a median ED treatment time of 4.0 minutes.
- 24 patients (3.4%) required full ED evaluation; 14 due to bed unavailability and 10 for clinical reasons identified during the rapid assessment.
- Of the 10 patients requiring further evaluation, 4 were admitted to the ICU and 6 to the ward. 1.1% of all directly admitted patients required ICU transfer within 12 hours.
Conclusions:
- The ED RAPID evaluation process is a feasible and effective method for safely managing direct hospital admissions of children.
- This protocol supports patient safety by identifying children who require a more comprehensive emergency department evaluation prior to inpatient admission.
Introduction:
Direct hospital admission of children without evaluation in the emergency department (ED) is common, but few guidelines exist to maximize safety by assessing patient stability. This report describes a novel approach to support patient safety.
Methods:
An interdisciplinary children's hospital team developed a brief ED-based evaluation process called the ED Rapid Assessment of Patients Intended for Inpatient Disposition (ED RAPID). It entails a brief evaluation of vital signs and clinical stability by the ED attending physician and nurse. Children deemed stable are admitted to inpatient wards, whereas those requiring immediate intervention undergo full ED evaluation and disposition. We assessed outcomes for all children evaluated through this process from March 2013 through February 2015.
Results:
During the study period, we identified 715 patients undergoing ED RAPID evaluation. Of these, we directly admitted 691 (96.4%) to the hospital ward after ED RAPID evaluation; median ED treatment time was 4.0 minutes. We transitioned 24 (3.4%) to full ED evaluation, 14 (2.0%) because a ward bed was unavailable, and 10 (1.4%) for clinical reasons identified in the evaluation. We admitted four of the 10 stopped (40% of stops, 0.6% of total) to an intensive care unit, and 6 (60% of stops, 0.8% of total) to the hospital ward after ED care. Eight children (1.1%) admitted to the hospital ward after ED RAPID evaluation required a transfer to an intensive care unit within 12 hours.
Conclusion:
The ED RAPID evaluation process for children directly admitted to the hospital was feasible and effective in this setting.
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